Responsiveness and Minimally Important Changes for Persian-version of Patient-Rated Tennis Elbow Evaluation Questionnaire in Patients with Lateral Elbow Tendinopathy Following Physiotherapy Intervention

Document Type : RESEARCH PAPER


1 Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran

2 1 Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran 2 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 2 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 3 Rothman Orthopaedics Florida at AdventHealth, Orlando, USA

4 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Evaluating responsiveness and calculating minimally important change (MIC) for the Persian-version
of the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire following physiotherapy in patients with lateral
elbow tendinopathy (LET).
Methods: We enrolled 82 patients with LET to complete the PRTEE. After completing four weeks of physiotherapy,
all patients were reevaluated by the PRTEE. The patients also rated their changes on a 7-point global rating of change
scale (GRoC). The receiver operating characteristic (ROC) curve and correlation analysis were used for evaluating the
responsiveness. The MIC was determined by determining a desirable cutoff on the ROC curve.
Results:The results showed a moderate relationship (Spearman’s correlation coefficient= 0.43-0.56) of total PRTEE,
pain subscale, and function subscale with the GRoC scale. The total PRTEE, pain subscale, and function subscale
revealed an area under the curve of 0.87, 0.82, and 0.83, respectively. We found the MICs 31.33, 14.5, and 15.5 points
for total PRTEE, pain subscale, and function subscale, respectively.
Conclusion: The Persian-version of the PRTEE questionnaire has acceptable responsiveness and can measure
changes in patients with LET following physiotherapy. We advocate using the PRTEE questionnaire in both clinical
settings and research.
Level of evidence: IV


  1. Peterson M, Butler S, Eriksson M, Svärdsudd K. A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy). Clin Rehabil. 2014; 28(9):862-72. doi: 10.1177/0269215514527595.
  2. Manias P, Stasinopoulos DJBjosm. A controlled clinical pilot trial to study the effectiveness of ice as a supplement to the exercise programme for the management of lateral elbow tendinopathy. Br J Sports Med. 2006; 40(1):81-5. doi: 10.1136/bjsm.2005.020909.
  3. Smidt N, Windt DAvander, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002; 359. doi: 10.1016/S0140-6736(02)07811-X.
  4. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005; 39 (7):411-22. doi: 10.1136/bjsm.2004.016170.
  5. Lee S, Ko Y, Lee W. Changes in Pain, Dysfunction, and Grip Strength of Patients with Acute Lateral Epicondylitis Caused by Frequency of Physical Therapy: A Randomized Controlled Trial. J Phys Ther Sci. 2014; 26 (7):1037-40. doi: 10.1589/jpts.26.1037.
  6. Ebrahimzadeh M, Moradi A, Vahedi E, Kachooei A, Birjandinejad A. Validity and reliability of the Persian version of shortened disabilities of the arm, shoulder and hand questionnaire (quick-DASH). Int J Prev Med. 2015; 6 (1):59. doi: 10.4103/2008-7802.160336.
  7. Vincent J, MacDermid JC. Patient-Rated Tennis Elbow Evaluation Questionnaire. J Physiother. 60 (4):240. doi: 10.1016/j.jphys.2014.08.002.
  8. MacDermid JC. The Patient-Rated Tennis Elbow Evaluation (PRTEE) User Manual. Hamilton, Canada: School of Rehabilitation Science, McMaster University. 2007.
  9. Rompe JD, Overend TJ, MacDermid JC. Validation of the Patient-rated Tennis Elbow Evaluation Questionnaire. J Hand Ther. 2007; 20 (1):3-11. doi: 10.1197/j.jht.2006.10.003.
  10. Cacchio A, Necozione S, MacDermid JC, et al. Cross-Cultural Adaptation and Measurement Properties of the Italian Version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire. Phys Ther. 2012; 92 (8):1036-45. doi: 10.2522/ptj.20110398.
  11. Hanyu T, Watanabe M, Masatomi T, Nishida K, Nakagawa T, Nishiura Y, et al. Reliability, validity, and responsiveness of the Japanese version of the patient-rated elbow evaluation. J Orthop Sci. 2013; 18 (5):712-9. doi: 10.1007/s00776-013-0408-z.
  12. Chung B, Wiley JP. Validity, responsiveness and reliability of the Patient-Rated Tennis Elbow Evaluation. J Hand Ther. 2010; 15 (3):62-8.
  13. Farazdaghi MR, Mansoori A, Vosoughi O, Yoosefinejad AK. Evaluation of the reliability and validity of the Persian version of Patient-Rated Elbow Evaluation questionnaire. Rheumatol. 2017; 37 (5):743-50. doi: 10.1007/s00296-016-3605-1.
  14. Mansoori A, Noorizadeh Dehkordi S, Mansour Sohani S, Nodehi Moghadam A. Cross-Cultural Adaptation and Determination of the Validity and Reliability of the Persian Version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire in Iranian Tennis Players. Func Disabil J. 2019; 2 (1):17-26.doi: 10.30699/fdisj.1.4.17
  15. Shafiee E, Farzad M, Macdermid JC, Beygi AS, Vafaei A, Farhoud A. Cross-cultural adaptation and measurement properties of the Patient-Rated Tennis Elbow Evaluation for the Persian language. J Hand Ther. 2020; 25 (2): 56-62.
  16. Guyatt G, Walter S, Norman GJJocd. Measuring change over time: assessing the usefulness of evaluative instruments. J Chronic Dis. 1987; 40 (2):171-8. doi: 10.1016/0021-9681(87)90069-5.
  17. Pengel LHM, Refshauge KM, Maher CG. Responsiveness of Pain, Disability, and Physical Impairment Outcomes in Patients with Low Back Pain. Spine. 2004; 29 (8):879-83. doi: 10.1097/00007632-200404150-00011.
  18. Negahban H, Mostafaee N, Sohani SM, Hessam M, Tabesh H, Montazeri A. Responsiveness and minimally important differences for selected Persian-version of outcome measures used in patients with patellofemoral pain syndrome. Disabil Rehabil. 2015; 37 (14):1285-90. doi: 10.3109/09638288.2014.962107.
  19. Husted JA, Cook RJ, Farewell VT, Gladman DD. Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol. 2000; 53 (5):459-68. doi: 10.1016/s0895-4356(99)00206-1.
  20. Hoogvliet P, Randsdorp MS, Dingemanse R, Koes BW, Huisstede BMA. Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. Br J Sports Med. 2013;47(17):1112-9. doi: 10.1136/bjsports-2012-091990.
  21. Mostafaee N, Divandari A, Negahban H, et al. Shoulder and scapula muscle training plus conventional physiotherapy versus conventional physiotherapy only: a randomized controlled trial of patients with lateral elbow tendinopathy. Physiother Theory Pract. 2022;38(9):1153-64.
  22. Mostafaee N, Negahban H, Shaterzadeh Yazdi MJ, Goharpey S, Mehravar M, Pirayeh N. Responsiveness of a Persian version of Knee Injury and Osteoarthritis Outcome Score and Tegner activity scale in athletes with anterior cruciate ligament reconstruction following physiotherapy treatment. Physiother Theory Pract. 2020; 36 (9):1019-26. doi: 10.1080/09593985.2018.1548672.
  23. Trudel D, Duley J, Zastrow I, Kerr EW, Davidson R, Macdermid JC. Rehabilitation for patients with lateral epicondylitis: a systematic review. J Hand Ther. 2004;17(2):243-66. doi: 10.1197/j.jht.2004.02.011.
  24. Ellenbecker TS, Nirschl R, Renstrom P. Current concepts in examination and treatment of elbow tendon injury. Sports Health. 2013; 5 (2):186-94. doi: 10.1177/1941738112464761.
  25. S Soer R, Reneman MF, Vroomen PCAJ, Stegeman P, Coppes MH. Responsiveness and Minimal Clinically Important Change of the Pain Disability Index in Patients with Chronic Back Pain. Spine. 2012; 37 (8):711-5. doi: 10.1097/BRS.0b013e31822c8a7a.
  26. Tamura Y, Seki K, Usami M, et al. Cultural adaptation and validating a Japanese version of the readiness for interprofessional learning scale (RIPLS). J Interprof Care. 2012; 26 (1):56-63. doi: 10.3109/13561820.2011.595848.
  27. Salehi R, Negahban H, Saghayezhian N, Saadat M. The Responsiveness of the Persian Version of Neck Disability Index and Functional Rating Index Following Physiotherapy Intervention in People with Chronic Neck Pain. Iran J Med Sci. 2019; 44 (5):390-6. doi: 10.30476/ijms.2019.44963.
  28. Hajian-Tilaki KJCjoim. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian J Intern Med. 2013; 4 (2):627.
  29. Youden WJJC. Index for rating diagnostic tests. 1950; 3 (1):32-5. doi: 10.1002/1097-0142(1950)3:1<32::aid-cncr2820030106>;2-3.
  30. Poltawski L, Watson TJHT. Measuring clinically important change with the Patient-rated Tennis Elbow Evaluation. J Hand Ther. 2011; 16 (3):52-7.
  31. Shafiee E, MacDermid JC, Walton D, Vincent JI, Grewal R. Psychometric properties and cross-cultural adaptation of the Patient-Rated Tennis Elbow Evaluation (PRTEE); a systematic review and meta-analysis. Disabil Rehabil. 2021; 1:1-16. doi: 10.1080/09638288.2021.1938248.
  32. Farzad M, MacDermid JC, Shafiee E, Beygi AS, Vafaei A, Varahra A, et al. Clinimetric testing of the Persian version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires in patients with lateral elbow tendinopathy. Disabil Rehabil. 2022;44(12):2902-7.
  33. van Kampen DA, Willems WJ, van Beers LWAH, Castelein RM, Scholtes VAB, Terwee CB. Determination and comparison of the smallest detectable change (SDC) and the minimal important change (MIC) of four-shoulder patient-reported outcome measures (PROMs). J Orthop Surg Res. 2013; 8 (1):40. doi: 10.1186/1749-799X-8-40.
  34. Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009; 17 (3):163-70. doi: 10.1179/jmt.2009.17.3.163.
  35. Lehman LA, Velozo CA. Ability to detect change in patient function: responsiveness designs and methods of calculation. J Hand Ther. 2010; 23 (4):361-71. doi: 10.1016/j.jht.2010.05.003.
  36. Norman GR, Stratford P, Regehr G. Methodological problems in the retrospective computation of responsiveness to change: the lesson of Cronbach. J Clin Epidemiol. 1997; 50 (8):869-79. doi: 10.1016/s0895-4356(97)00097-8.